Minimally invasivethyroidectomy: A cosmetic alternative to standard thyroidectomy

Background: We report on minimally invasive thyroidectomy (MIT) through a 2–4cm incision hypothesize similar clinical results to standard open thyroidectomy. Methods: Between January 2019 and March 2020, 61 MIT were evaluated for clinical outcomes, and patient satisfaction on a 1–10 scale. Results: The 61 study patients underwent MIT procedure. The final diagnoses were benign nodular goitre (63%), and papillary thyroid carcinoma (37%). Five patients had temporary recurrent laryngeal nerve paresis and four patients had temporary hypocalcemia. Conclusion: In selected patients, MIT through a 1,5–3cm incision assistance is a safe alternative to standard open thyroidectomy in the hands of an experienced surgeon. The clinical results are equivalent and patient satisfaction is significantly improved.

Better Outcomes With Minimally Invasive Thyroidectomy Than Conventional Thyroidectomy

Introduction Aim of this study was to evaluate our results from conventional and minimally invasive thyroidectomy and compare their outcomes. Materials and Methods 137 patients undergone conventional and minimally invasive thyroidectomy (video-assisted and open technique with mini-cervicotomy) were reviewed. Demographic data, blood loss, operative time, postoperative pain, cosmetic outcome and complications were examined and compared. Results Minimally invasive group consists of 53 cases(39%) and conventional group is composed of 84 cases(61%). No conversion from minimally invasive to conventional techniques was observed. In minimally invasive group, 25 patients(47%) had differantiated thyroid carcinoma and 28 patients(53%) had benign pathologies. Postoperative complications include transient hypocalcemia in 5 patients(3.6%) (4 in conventional, 1 in minimally invasive group), permanent hypocalcemia in 4 patients(3%) (3 in conventional, 1 in minimally invasive group), unilateral vocal cord paralysis in 2 patients(2%) (1 in conventional, 1 in minimally invasive group). Operative time was similar in both groups; however blood loss during surgery, postoperative pain was significantly lower in minimally invasive group. Conclusion Minimally invasive techniques could be implemented on selected carcinoma patients and results in equal safety and less surgical morbidity. Keywords: minimally invasive thyroidectomy, thyroid cancer, MIVAT

Transoral Vestibular Thyroidectomy: Current State of Affairs and Considerations for the Future

Context The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a recently described procedure for surgical management of select thyroid pathology that avoids a cutaneous scar. TOETVA is far from the first described remote-access approach to the thyroid. In fact, numerous such techniques have been described over the past 20 years, although none has gained widespread implementation in North America or Europe. However, with its rapid growth worldwide and excellent outcomes to date, TOETVA may succeed where these prior techniques have failed. Evidence Acquisition The English literature was reviewed using the following keywords: transoral thyroidectomy, remote-access thyroidectomy, minimally invasive thyroidectomy, and TOETVA. Because three systematic reviews of this technique were recently conducted, this manuscript does not seek to provide a fourth. Rather, we summarize salient findings from these reviews and focus on candidates for the procedure, technique-specific characteristics that have led to early success with TOETVA, and prospects for the future. Evidence Synthesis TOETVA is the only thyroidectomy approach obviating the need for a cutaneous incision, and it offers several advantages over previously described remote-access thyroidectomy techniques. These include a favorable anatomic surgical perspective, a comparatively short learning curve, no requirement for expensive instrumentation, and a broad inclusion criterion. These characteristics have facilitated the excellent surgical outcomes to date. Conclusions TOETVA is a suitable surgical option with proven safety and feasibility for a carefully selected patient population. The potential value of the procedure outside enhanced cosmesis continues to be defined.

Thyroidectomy: Technique, Tips, and Troubleshooting

Historically, thyroidectomy was associated with a high mortality rate, now understood to likely be secondary to postoperative hypocalcemia. In the modern age, perioperative morbidity and mortality rates are extremely low, although some complications, such as recurrent laryngeal nerve injury, can have significant consequences. Understanding the safe approach to total thyroidectomy and thyroid lobectomy is key to minimizing operative morbidity. In particular, the capsular dissection technique facilitates identification and preservation of the recurrent laryngeal nerve and parathyroid glands. The postoperative care of the patient, including diagnosis and management of the more common complications such as hematoma or hypocalcemia, is crucial to optimize patient outcomes. Although novel thyroidectomy techniques have been developed to avoid or minimize the traditional neck incision, these approaches have not become widely used. This review contains 9 figures, 1 table, and 29 references. Key Words: capsular dissection, external branch of the superior laryngeal nerve, intraoperative nerve monitoring, minimally invasive thyroidectomy, postoperative hematoma, postoperative hoarseness, postoperative hypocalcemia, recurrent laryngeal nerve, remote access thyroidectomy